Valor de la angiografía coronaria por tomografía computarizadaen el diagnóstico de las anomalías coronarias / Role of coronary computed tomography angiography for the diagnosis of coronary anomalies

Background: Coronary anomalies are rare heart diseases that can cause sudden cardiac death, especially in young individuals. Coronary computed tomography angiography delivers a three-dimensional view of excellent quality with information of the origin, course and anatomic relationships of the anomalous vessel, allowing differentiation between benign and malignant variants, entities that require different management and treatment. Aim: To show that coronary computed tomography angiography is the non-invasive technique of choice for the evaluation of a coronary anomaly due to its high diagnostic accuracy. Material and Methods: Between 2008 and 2014, 368 coronary computed tomography angiographies were carried out. Six (1.6%) patients had a coronary anomaly. Results: The age of these six patients ranged from 38 to 82 years (five were women). The coronary computed tomography angiography was requested due to cardiac symptoms (angina and dyspnea) in two patients, after a selective coronary arteriography to obtain additional information of the coronary anomaly in three patients, and after a cardiorespiratory arrest in one patient. Three patients had an anomaly of the right coronary artery, two patients had an anomaly of the left coronary artery and one patient had absent left main coronary artery. In five patients the coronary anomaly was malignant. Conclusions: Coronary computed tomography angiography is a robust diagnostic method to evaluate patients with suspected coronary anomalies.

Hiperpotasemia extrema no fatal en un caso de acidosis láctica por sobreingesta de metformina / Non-fatal hyperkalemia in lactic acidosis due to metformin overdose. Report of one case

We report a 74-year-old man with diabetes mellitus type 2 and hypertension, who recently underwent coronary bypass surgery due to severe triple vessel disease receiving cardiological and combined antidiabetic therapy, including metformin 4 g/day. He was admitted with abdominal pain, nausea, vomiting, diarrhea and loss of consciousness. At admission, he was disoriented and agitated with signs of poor perfusion. His blood pressure was 80/70 mmHg, pulse rate 40 beats/min, respiratory rate 20-breaths/min, and axillary temperature 35°C. Biochemical profile revealed an extreme hyperkalemia of 15.4 mEq/L (double checked), elevated creatinine, uremia and brain natriuretic peptide; hypoglycemia (blood glucose 68 mg/dl) and normal C Reactive Protein. Arterial blood gases revealed severe lactic acidemia. The electrocardiogram showed sinus bradycardia, simple AV block, widened QRS with prominent T wave and prolonged QT. He was admitted to the Intensive Care Unit (ICU) with the suspicion of lactic acidosis associated with metformin, receiving fluid management, intravenous hypertonic glucose plus insulin and sodium bicarbonate, mechanical ventilation, vasopressor therapy, a temporary pacemaker lead, in addition to continuous venovenous hemodiafiltration. Two days later, the patient experienced a significant clinical improvement with normalization of the acid-base status, plasma lactate and potassium levels. On day 9, diuresis was recovered, creatinine and uremia returned to normal levels and the patient was discharged from the ICU.

Displasia arritmogénica del ventrículo derecho con compromiso de ventrículo izquierdo: valor diagnóstico de la resonancia cardiaca / Cardiac magnetic resonance in arrhythmogenic right ventricular dysplasia: Report of two cases

Arrhythmogenic right ventricular dysplasia is an inherited condition characterized by replacement of normal myocardium by fatty or fibro-fatty tissue, which mainly affects the right ventricle. The most frequent form of presentation is ventricular tachycardia or sudden death, whose origin is considered to be a product of fibrous or fatty infiltration of the myocardium. This structural damage can be detected by cardiac magnetic resonance imaging (MR). We report two patients with ventricular tachycardia due to arrhythmogenic right ventricular dysplasia. A 49 year-old female with a history of ventricular tachycardia. EKG showed epsilon waves and a prolonged QTc. Echocardiogram showed right ventricular dilatation and dysfunction. MR showed right ventricular fatty infiltration. An implantable cardioverter-defibrillator was installed to the patient. A 37 year-old male was admitted for recurrent syncope. On admission a ventricular tachycardia was detected. An echocardiogram showed right ventricular dilatation and dysfunction. MR showed a large zone of fibrosis in the right ventricle. An implantable cardioverter-defibrillator was also installed.

Trombosis bilateral de venas renales e insuficiencia renal aguda secundaria a trombosis de un filtro en vena cava inferior / Bilateral renal vein thrombosis and acute renal failure due to inferior vena cava filter thrombosis. Report of one case

Bilateral renal vein thrombosis is an unusual etiology of acute renal failure and usually is associated with nephrotic syndrome. We report a 77-year-old man, consulting in the emergency room for anuria that appeared 24 hours after a syncope. The patient was carrier of an inferior vena cava filter prophylactically installed 17 months earlier and was not receiving anticoagulation. Serum creatinine on admission was 5.45 mg/dl and blood urea nitrogen was 54 mg/dl. Computed tomography and Doppler ultrasonography showed an extensive thrombosis of inferior vena cava and both renal veins. Heparin therapy was started with a rapid recovery of renal function and diuresis.

Asistencia ventricular intracorpórea en falla cardiaca terminal / Left ventricular assistant devices for end-stage heart failure: report of two cases

In the last 2 decades, there have been significant advances in medical treatment of heart failure. However, there is a group of patients who are refractory to the available medical therapy and progress inevitably to a state of end-stage heart failure, whose only therapeutic alternative is cardiac transplantation. But this is an option limited by the scarce availability of donors. Therefore many patients die waiting for an organ. Recently, extra or intracorporeal left ventricular devices have emerged as a viable alternative for patients with end-stage heart failure waiting for a heart transplant. These devices discharge the left ventricle, increasing cardiac output and improving systemic perfusion. This year, in our hospital we began a left ventricular device implantation program for the most severely ill patients on the waiting list for cardiac transplantation. We report two males aged 30 and 53 years, in whom a left ventricular device was successfully implanted, using a minimally invasive surgical technique developed at the University of Hannover in Germany.

Mixoma ventricular izquierdo asintomático diagnosticado circunstancialmente por ecocardiografía / Asymptomatic left ventricular myxoma incidentally diagnosed by echocardiography. Report of one case

We report a 50 year-old hypertensive and asymptomatic woman in whom a left ventricular tumor was found on a routine two-dimensional transthoracic echocardiogram. Complementary 3D echocardiography, cardiac magnetic resonance and cardiac computed tomography allowed the diagnosis of a calcified left ventricular myxoma. Surgical treatment was performed through a transaortic transvalvular approach with tumor resection and implantation of a pericardial bovine patch. This case confirms the importance of transthoracic echocardiography in the diagnosis of cardiac tumors and the complementary role of 3D echocardiography, cardiac magnetic resonance imaging and computed tomography for the differential diagnosis before surgery.

Síndrome nefrótico e injuria renal aguda con microangiopatía trombótica en mujer con enfermedad celíaca: Caso clínico / Nephrotic syndrome and acute kidney injury associated with celiac disease: Report of one case

Celiac disease may be associated with other autoimmune diseases and exceptionally with glomerulopathies and nephrotic syndrome. Associations have been reported with IgA nephropathy, membranoproliferative glomerulonephritis, membranous glomerulopathy and minimal change disease. We report a 63-year-old woman who simultaneously presented with massive nephrotic syndrome (proteinuria 46 g/day) and cachexia due to a malabsorption syndrome secondary to celiac disease. The course of her diseases was complicated with cardiomyopathy due to severe malnutrition, septic shock, acute kidney injury that required dialysis for seven weeks and severe hypertension. A renal biopsy showed a membranoproliferative pattern of injury secondary to a thrombotic microangiopathy and diffusepodocyte damage. Fouryears later, the patient was in good general health, the glomerular filtration rate was 30 ml/min/1.73m² and there was non-nephrotic proteinuria.

Enfermedad coronaria aneurism tica severa en un adolescente con angina de esfuerzo secundaria a enfermedad de Kawasaki no diagnosticada previamente / Severe aneurisma I coronary artery disease probably caused by Kawasaki disease. Report of one case

We report a 16 year old male with a history of angina on exertion. A treadmill exercise test was positive for ischemia in concordance with a Thallium-201 scintigraphy showing a septal and infero-posterior reversible myocardial perfusi¢n defect. Coronary angiography disclosed severe aneurysmal coronary artery disease. Bilateral internal mammary coronary artery bypass grafting was successfully performed. Kawasaki disease is the most likely etiology, although not confirmed.

Endocarditis infecciosa, experiencia en los últimos seis años

Estudiamos 35 pacientes con E.I. entre Enero de 1980 y Diciembre de 1985; 21 eran hombres y la edad promedio fue de 36,7 años (rango 16 a 70). Se definió E.I. como la presencia de un cuadro febril, con soplo cardíaco orgánico, leucocitosis y/o vegetaciones al ecocardiograma modo M. en ausencia de otro cuadro infeccioso extracardíaco. El promedio entre el comienzo de los síntomas y el diagnóstico fue de 38 días. La cardiopatía reumática fue la enfermedad de base más frecuente (29%), seguida de la endocarditis protésica (23%). En un 23% no se objetivó cardiopatía previa. En el grupo de pacientes reumáticos la válcula aórtica fue la que se compometió con mayor frecuencia (6/8). El 49% de los casos tuvo hemocultivos positivos, con desarrollo de estreptococo viridans en 23%. El ecocardiograma modo M mostró vegetaciones en un 60% de los casos. La complicación más frecuente fue la insuficiencia cardíaca (45%). En la mayoría de los casos el tratamiento fue médico y sólo un 14% requerió cirugia por compromiso hemodinámico severo. La mortalidad de la serie fue 26%. la edad y la presencia de complicaciones, especialmente la insuficiencia cardíaca, fueron determinantes en ella